The X-ray in dental practice:
The crime of the agePart 1 (15 pages; PDF)Part 2 (17 pages; PDF)
By C. Edmund Kells, DDS
Originally published: March 1920 in the Journal of the National Dental Association (forerunner to JADA)

Summary: C. Edmund Kells was a dental pioneer who championed the use of X-rays in dentistry during the late 19th century and early 20th century. "The X-Ray in Dental Practice" is a paper read by Dr. Kells at a 1919 Association meeting in New Orleans. Much of the paper discusses focal infection theory, which Dr. Kells argued was leading to the unnecessary extraction of teeth. He also made it clear that dental X-rays should be used to enhance dentistry, and not to encourage the "mania for extracting devitalized teeth."

Summary: Dr. Sigurd P. Ramfjord’s article drew on evidence from a series of studies, the Michigan Longitudinal Studies, conducted over 20 years to investigate the outcomes of periodontal therapy. These studies, the first of their kind, led Dr. Ramfjord to the conclusion that because the long-term outcome of various forms of periodontal therapy were similar, pocket elimination procedures with recession and root denudation associated with osseous surgery were not necessary for maintenance of the dentition’s long-term health and function. This conclusion sparked debate—but, as Dr. Ramfjord later noted, there is no absolute truth in science, including the science of dentistry.

Summary: As noted in the commentary, this JADA Landmark article by Drs. Isaac Schour and Maury Massler “proved to a starting point for recognition of normal development of the dentition and occlusion, forming the basis of pediatric dentistry and orthodontics.” Originally published in July of 1941, the article has gone on to be one of the most cited articles in dental literature. It also produced development tables and charts (see image) that were frequently used upon publication, and continue to be referenced in educational settings.

Summary: This 1953 article by Dr. Robert J. Nelsen, Carl E. Pelander and John W. Kumpula helped pave the way for using increased rotary speeds in tooth-cutting procedures. Dr. Nelsen and colleagues went on to create the prototype for the first commercially produced dental handpiece with the turbine placed in the head of the handpiece. Drs. J. Robert Eshleman and David C. Sarrett explain how high-speed air turbine handpieces improved dentistry for both dentists and patients, sparking a practice transformation, arguably, more rapid than any the profession has ever seen. The commentary includes an interview with five dentists who were in dental school when the handpieces made their debut in the 1960s.

Summary: This 1954 article by Drs. Richard Tiecke and Joseph Bernier was one of the first to spotlight the importance of identifying oral cancer risk factors in their earliest stages in order to improve treatment outcomes. In particular the authors suggest that clinicians closely monitor those patients who use tobacco or who consume alcohol heavily. As commentator Dr. J.W. Hellstein, DDS, MS, explains, if today’s numbers tell us anything—23,000 new cases, 4,500 deaths—it’s that oral cancer continues to “drive our profession so that we can better serve our patients and improve the health of all people.”

Summary: As commentator William H. Bowen, PhD, DSc, notes, the fact that Dr. Ast and colleagues conducted this study in the 1940s is rather remarkable. Attitudes toward fluoride in water supplies had tended toward the negative, focusing on reducing fluorosis. In the late 1930s, researchers began positing that fluoride in water might contribute to reduced prevalence of caries, and in 1944 Dr. Ast began a 10-year study of fluoridation in two New York towns that would lay the groundwork for widespread fluoridation of public water. That measure, as dentists know, is considered one of the greatest public health achievements of the 20th century.

Summary: “The true age of dental composites was launched with this initial [investigation] into coupling agents,” writes commentator Stephen C. Bayne, MS, PhD. Although the polymer material described in this article by Dr. Rafael Bowen would revolutionize restorative dentistry and become a familiar part of everyday dentistry, Dr. Bowen didn’t even call it by the name by which dentists know it now: “composite.”

Summary: The introduction of acid etching to condition the enamel surface as a means of retaining pit-and- fissure sealants must be considered one of the foremost discoveries in dentistry, writes commentator Domenick T. Zero, DDS, MS. The technique also has had a far-reaching effect on restorative and esthetic adhesive dentistry. He credits Dr. Michael Buonocore with driving the “blossoming” of adhesive dentistry and the prevention of early carious lesions.

Summary: The early days of the AIDS epidemic were pervaded by “misinformation, panic and fear,” write commentators Stephen N. Abel, DDS, MSD, and Sanjiv Shah, MD, MPH. The work by Dr. Sol Silverman Jr. and his colleagues took a scientific approach to an emotion-fraught topic. These investigators not only provided dentists with essential clinical information for treating patients with AIDS, but they also issued a call for an interdisciplinary collaborative care model that has become increasingly the norm with AIDS— and with other diseases.

Summary: Dr. Sigurd P. Ramfjord’s article drew on evidence from a series of studies, the Michigan Longitudinal Studies, conducted over 20 years to investigate the outcomes of periodontal therapy. These studies, the first of their kind, led Dr. Ramfjord to the conclusion that because the long-term outcome of various forms of periodontal therapy were similar, pocket elimination procedures with recession and root denudation associated with osseous surgery were not necessary for maintenance of the dentition’s long-term health and function. This conclusion sparked debate—but, as Dr. Ramfjord later noted, there is no absolute truth in science, including the science of dentistry.